逆行性腎臟內手術治療鹿角狀結石:案例報告

陳建凱、石宏仁

彰化基督教醫院 外科部 泌尿科

Retrograde intrarenal surgery for a complete renal staghorn stone: a case report

Jian-Kai Chen, Hung-Jen Shih

Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan

Introduction: Staghorn renal stone needs the surgical treatment to prevent severe complications. The gold standard treatment for staghorn calculi is percutaneous nephrolithotomy (PCNL). Nowadays, the improved endoscopic instruments and laser devices make the retrograde intrarenal surgery (RIRS) being effective for dealing with the renal stone. Here, we present a patient with staghorn renal stone about 5.3 cm x 4.4 cm under the treatment of retrograde intrarenal surgery.

Case report: The patient is a 71-years-old male farmer with a history of coronary arterial disease with myocardial infarction post successful percutaneous coronary intervention, hypertension, and hyperlipidemia. About 7 years ago, a left large renal stone was found by X-ray film. The patient lost following up until 2022. He visited our urology out-patient department due to the complaint of painless gross hematuria for 1 month. Besides, gas passage on and off during urination was also noted. A kidney, ureter, and bladder (KUB) X-ray showed complete left renal staghorn stone. After discussion, the patient decided to receive the staged retrograde intrarenal surgery. At first time of surgery, under the C arm assistance, the 11/13 ureter sheath was inserted. The prior location of which stone were disintegrated by Holmium laser were upper, middle calyx and partial renal pelvis. The partial renal pelvis and lower calyx part of staghorn stone were disintegrated on the second time operation. The operation time were 137 minutes and 141 minutes respectively. After the operation, there was no fever but only left flank soreness happened sometimes. The following up KUB showed a small residual stone at left lower calyx.

Conclusions: We successfully treated renal staghorn stone with two stages RIRS, no complications was encountered. RIRS can be carried out effectively and safely for renal staghorn stone in selected patient.